Scars come in an infinite variety depending on location, shape, age, origin and skin type. Some scars are just skin deep, others carry an emotional burden. Some like to flaunt their scars, most would just rather never have to look at them.
In general, fresh traumatic and surgical scars tend to be more amenable to treatment than others. The same goes for stretch marks and acne scars. Keloids are traditionally the most treatment resistant.
• from facelifts, breast surgery, abdominoplasty, cancer sx
• UltraPulseCO2 laser for flattening
• Pulsed dye laser for the red color
• Fraxel Re:pair for retexturing
• Silicone gel sheets to enhance or maintain flattening
• Ice pick acne scars; punch excision + Fraxel Re:store
• Boxcar acne cars, also seen in chickenpox scars, do well with punch elevation (cutting out the base and elevating the scar) or subcision (severing all the attachments under the scar) + filler to keep the scar elevated followed by FXL resurfacing
• Atrophic and undulating acne scars respond well with the Fraxel Re:store or Fraxel Re:pair resurfacing and Sculptra injections to restore fullness of skin
These are due to excessive collagen deposition. As opposed to keloids, these scars remain confined to the area of injury and usually flatten out within 18 months. They respond beautifully to Fraxel Re:store treatments.
Keloids develop more likely in darker skin types, over joints and breastbone in lighter skin types and when the scar goes against the grain of the skin. They also are due to excessive deposition of collagen, but these scars typically extend beyond the area of injury and never disappear. Keloids hurt, itch, contract, pull and disfigure. Patience is of primordial importance when dealing with keloids. They are notoriously fickle in their response to treatment, especially if too aggressive. The research has shown that keloids respond best to CO2 lasers powerful enough to traverse the entire thickness of the lesion (=high energy) but used at minimal density (5%) and longer inter treatment intervals.
In the past, keloids were traditionally injected with high concentration cortisone to suppress their growth. Unfortunately, they also created a thinning and a depression of the skin surrounding the keloid. We therefore only use 5 fluoro-uracil for that purpose because it does not cause atrophy. Local Botox injections have been hugely helpful as well.
• Burn scars
• fresh or mature: Fraxel Re:store laser, preferably while still early
• Scars due to self-mutilation and hesitation marks from attempts at wrist slicing are best treated with the Fraxel Re:store laser while still fresh.